Evaluation of contemporary echocardiographic and histomorphology parameters in predicting mortality in patients with endomyocardial biopsy-proven cardiac AL amyloidosis

Koutroumpakis, Efstratios; Niku, Adam; Black, Christopher K.; Ali, Abdelrahman; Sadaf, Humaira; Song, Juhee; Palaskas, Nicolas; Iliescu, Cezar; Durand, Jean-Bernard; Yusuf, Syed Wamique; Lee, Hans C.; Buja, L. Maximilian; Deswal, Anita; Banchs, José

doi:10.3389/fcvm.2022.1073804

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by the extracellular accumulation of amyloid in the extracellular space. Histology shows cardiomyocyte degeneration, the extent and pattern of interstitial amyloid deposits and vascular deposits, endomyocardial deposition, or fibrosis (Koutroumpakis et al., 2023 ; Larsen et al., 2016 ; Pucci et al., 2021 ). The QRS abnormalities in CA patients are heterogeneous.…”

Section: Pathologymentioning

confidence: 99%

ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm

Bacharova,

Chevalier,

Gorenek

et al. 2023

Noninvasive Electrocardiol

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The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non‐spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non‐spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non‐spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.

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Section: Pathologymentioning

confidence: 99%